Eating For Energy (In Ways That Actually Work)

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Snacks & Hacks: The Real Energy Boosters

Declining energy levels are a common complaint of people getting older, and this specific kind of “getting older” is starting earlier and earlier (even Gen-Z are already getting in line for this one). For people of all ages, however, diet is often a large part of the issue.

The problem:

It can sometimes seem, when it comes to food and energy levels, that we have a choice:

  • Don’t eat (energy levels decline)
  • Eat quick-release energy snacks (energy spikes and crashes)
  • Eat slow-release energy meals (oh hi, post-dinner slump)

But, this minefield can be avoided! Advice follows…

Skip the quasi-injectables

Anything the supermarket recommends for rapid energy can be immediately thrown out (e.g. sugary energy drinks, glucose tablets, and the like).

Same goes for candy of most sorts (if the first ingredient is sugar, it’s not good for your energy levels).

Unless you are diabetic and need an emergency option to keep with you in case of a hypo, the above things have no place on a healthy shopping list.

Aside from that, if you have been leaning on these heavily, you might want to check out yesterday’s main feature:

The Not-So-Sweet Science Of Sugar Addiction

…and if your knee-jerk response is “I’m not addicted; I just enjoy…” then ok, test that! Skip it for this month.

  • If you succeed, you’ll be in better health.
  • If you don’t, you’ll be aware of something that might benefit from more attention.

Fruit and nuts are your best friends

Unless you are allergic, in which case, obviously skip your allergen(s).

But for most of us, we were born to eat fruit and nuts. Literally, those two things are amongst the oldest and most well-established parts of human diet, which means that our bodies have had a very long time to evolve the perfect fruit-and-nut-enjoying abilities, and reap the nutritional benefits.

Nuts are high in fat (healthy fats) and that fat is a great source of energy’s easy for the body to get from the food, and/but doesn’t result in blood sugar spikes (and thus crashes) because, well, it’s not a sugar.

See also: Why You Should Diversify Your Nuts

Fruit is high in sugars, and/but high in fiber that slows the absorption into a nice gentle curve, and also contains highly bioavailable vitamins to perk you up and polyphenols to take care of your long-term health too.

Be warned though: fruit juice does not work the same as actual fruit; because the fiber has been stripped and it’s a liquid, those sugars are zipping straight in exactly the same as a sugary energy drink.

See also: Which Sugars Are Healthier, And Which Are Just The Same?

Slow release carbs yes, but…

Eating a bowl of wholegrain pasta is great if you don’t have to do anything much immediately afterwards, but it won’t brighten your immediately available energy much—on the contrary, energy will be being used for digestion for a while.

So if you want to eat slow-release carbs, make it a smaller portion of something more-nutrient dense, like oats or lentils. This way, the metabolic load will be smaller (because the portion was smaller) but the higher protein content will prompt satiety sooner (so you addressed your hunger with a smaller portion) and the iron and B vitamins will be good for your energy too.

See also: Should You Go Light Or Heavy On Carbs?

Animal, vegetable, or mineral?

At the mention of iron and B vitamins, you might be thinking about various animal products that might work too.

If you are vegetarian or vegan: stick to that; it’s what your gut microbiome is used to now, and putting an animal product in will likely make you feel ill.

If you have them in your diet already, here’s a quick rundown of how broad categories of animal product work (or not) for energy:

  • Meat: nope. Well, the fat, if applicable, will give you some energy, but less than you need just to digest the meat. This, by the way, is a likely part of why the paleo diet is good for short term weight loss. But it’s not very healthy.
  • Fish: healthier than the above, but for energy purposes, just the same.
  • Dairy: high-fat dairy, such as cream and butter, are good sources of quick energy. Be aware if they contain lactose though, that this is a sugar and can be back to spiking blood sugars.
    • As an aside for diabetics: this is why milk can be quite good for correcting a hypo: the lactose provides immediate sugar, and the fat keeps it more balanced afterwards
  • Eggs: again the fat is a good source of quick energy, and the protein is easier to digest than that of meat (after all, egg protein is literally made to be consumed by an embryo, while meat protein is made to be a functional muscle of an animal), so the metabolic load isn’t too strenuous. Assuming you’re doing a moderate consumption (under 3 eggs per day) and not Sylvester Stallone-style 12-egg smoothies, you’re good to go.

See also: Do We Need Animal Products To Be Healthy?

…and while you’re at it, check out:

Eggs: Nutritional Powerhouse or Heart-Health Timebomb?

(spoiler: it’s the former; the title was because it was a mythbusting edition)

Hydration considerations

Lastly, food that is hydrating will be more energizing than food that is not, so how does your snack/meal rank on a scale of watermelon to saltines?

You may be thinking: “But you said to eat nuts! They’re not hydrating at all!”, in which case, indeed, drink water with them, or better yet, enjoy them alongside fruit (hydration from food is better than hydration from drinking water).

And as for those saltines? Salt is not your friend (unless you are low on sodium, because then that can sap your energy)

How to tell if you are low on sodium: put a little bit (e.g. ¼ tsp) of salt into a teaspoon and taste it; does it taste unpleasantly salty? If not, you were low on sodium. Have a little more at five minute intervals, until it tastes unpleasantly salty. Alternatively have a healthy snack that nonetheless contains a little salt.

If you otherwise eat salty food as an energy-giving snack, you risk becoming dehydrated and bloated, neither of which are energizing conditions.

Dehydrated and bloated at once? Yes, the two often come together, even though it usually doesn’t feel like it. Basically, if we consume too much salty food, our homeostatic system goes into overdrive to try to fix it, borrows a portion of our body’s water reserves to save us from the salt, and leaves us dehydrated, bloated, and sluggish.

For more on salt in general, check out:

How Too Much Salt Can Lead To Organ Failure: Lesser-Known Salt Health Risks

Take care!

Don’t Forget…

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  • Sweet Potato & Black Bean Tacos

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Fiber, protein, and polyphenols! What more could one ask for? Well, great taste and warm healthy goodness, which these deliver:

    You will need

    For the sweet potatoes:

    • 2 medium sweet potatoes, cubed (we recommend leaving the skin on, but you can peel them if you really want to)
    • 1 tbsp extra virgin olive oil
    • 2 tsp garlic powder
    • 2 tsp smoked paprika
    • 1 tsp chili powder
    • 1 tsp black pepper
    • 1 tsp ground cumin
    • 1 tsp ground turmeric
    • ½ tsp MSG or 1 tsp low-sodium salt

    For the black beans:

    • 2 cans black beans, drained and rinsed (or 2 cups black beans that you cooked yourself)
    • ¼ bulb garlic, minced
    • 1 fresh jalapeño finely chopped (or ¼ cup jalapeños from a jar, finely chopped) ← adjust quantities per your preference and per the quality of the pepper(s) you’re using; we can’t judge that from here without tasting them, so we give a good basic starting suggestion.
    • 2 tsp black pepper
    • 1 tsp red chili flakes
    • ½ tsp MSG or 1 tsp low-sodium salt

    For serving:

    • 8 small corn tortillas, or your preference if substituting
    • 1 avocado, pitted, peeled, cubed, and tossed in lime juice ← we’re mentioning this here because you want to do this as soon as you cut it, to avoid oxidation
    • Any other salad you’d like to include; fresh parsley is also a good option when it comes to greenery, or cilantro if you don’t have the soap gene
    • Tomato salsa (quantity and spice level per your preference)

    Method

    (we suggest you read everything at least once before doing anything)

    1) Preheat the oven to 400°F / 200°C.

    2) Toss the sweet potato cubes in a large bowl with the rest of the ingredients from the sweet potato section above, ensuring they are evenly coated.

    3) Bake them in the oven, on a baking tray lined with baking paper, for about 30 minutes or until tender inside and crispy at the edges. Turn them over halfway through.

    4) While that’s happening, mix the black beans in a bowl with the other ingredients from the black bean section above, and heat them gently. You could do this in a saucepan, but honestly, while it’s not glamorous, the microwave is actually better for this. Note: many people find the microwave cooks food unevenly, but there are two reasons for this and they’re both easily fixable:

    • instead of using high power for x minutes, use medium power for 2x minutes; this will produce better results
    • instead of putting the food just in a bowl, jug, or similar, use a wide bowl or similar container, and then inside that, place a small empty microwave-safe glass jar or similar upturned in the middle, and then add the food around it, so that the food is arranged in a donut shape rather than a wide cylinder shape. This means there is no “middle bit” to go underheated while the edges are heated excessively; instead, it will heat through evenly.

    If you really don’t want to do that though, use a saucepan on a very low heat, add a small amount of liquid (or tomato salsa), and stir constantly.

    5) Heat the tortillas in a dry skillet for about 30 seconds each on each side, when ready to serve.

    6) Assemble the tacos; you can do this how you like but a good order of operations is: tortilla, leafy salad (if using), potato, beans, non-leafy salad including avocado, salsa or other topping per your preference.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Mammography AI Can Cost Patients Extra. Is It Worth It?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    As I checked in at a Manhattan radiology clinic for my annual mammogram in November, the front desk staffer reviewing my paperwork asked an unexpected question: Would I like to spend $40 for an artificial intelligence analysis of my mammogram? It’s not covered by insurance, she added.

    I had no idea how to evaluate that offer. Feeling upsold, I said no. But it got me thinking: Is this something I should add to my regular screening routine? Is my regular mammogram not accurate enough? If this AI analysis is so great, why doesn’t insurance cover it?

    I’m not the only person posing such questions. The mother of a colleague had a similar experience when she went for a mammogram recently at a suburban Baltimore clinic. She was given a pink pamphlet that said: “You Deserve More. More Accuracy. More Confidence. More power with artificial intelligence behind your mammogram.” The price tag was the same: $40. She also declined.

    In recent years, AI software that helps radiologists detect problems or diagnose cancer using mammography has been moving into clinical use. The software can store and evaluate large datasets of images and identify patterns and abnormalities that human radiologists might miss. It typically highlights potential problem areas in an image and assesses any likely malignancies. This extra review has enormous potential to improve the detection of suspicious breast masses and lead to earlier diagnoses of breast cancer.

    While studies showing better detection rates are extremely encouraging, some radiologists say, more research and evaluation are needed before drawing conclusions about the value of the routine use of these tools in regular clinical practice.

    “I see the promise and I hope it will help us,” said Etta Pisano, a radiologist who is chief research officer at the American College of Radiology, a professional group for radiologists. However, “it really is ambiguous at this point whether it will benefit an individual woman,” she said. “We do need more information.”

    The radiology clinics that my colleague’s mother and I visited are both part of RadNet, a company with a network of more than 350 imaging centers around the country. RadNet introduced its AI product for mammography in New York and New Jersey last February and has since rolled it out in several other states, according to Gregory Sorensen, the company’s chief science officer.

    Sorensen pointed to research the company conducted with 18 radiologists, some of whom were specialists in breast mammography and some of whom were generalists who spent less than 75% of their time reading mammograms. The doctors were asked to find the cancers in 240 images, with and without AI. Every doctor’s performance improved using AI, Sorensen said.

    Among all radiologists, “not every doctor is equally good,” Sorensen said. With RadNet’s AI tool, “it’s as if all patients get the benefit of our very top performer.”

    But is the tech analysis worth the extra cost to patients? There’s no easy answer.

    “Some people are always going to be more anxious about their mammograms, and using AI may give them more reassurance,” said Laura Heacock, a breast imaging specialist at NYU Langone Health’s Perlmutter Cancer Center in New York. The health system has developed AI models and is testing the technology with mammograms but doesn’t yet offer it to patients, she said.

    Still, Heacock said, women shouldn’t worry that they need to get an additional AI analysis if it’s offered.

    “At the end of the day, you still have an expert breast imager interpreting your mammogram, and that is the standard of care,” she said.

    About 1 in 8 women will be diagnosed with breast cancer during their lifetime, and regular screening mammograms are recommended to help identify cancerous tumors early. But mammograms are hardly foolproof: They miss about 20% of breast cancers, according to the National Cancer Institute.

    The FDA has authorized roughly two dozen AI products to help detect and diagnose cancer from mammograms. However, there are currently no billing codes radiologists can use to charge health plans for the use of AI to interpret mammograms. Typically, the federal Centers for Medicare & Medicaid Services would introduce new billing codes and private health plans would follow their lead for payment. But that hasn’t happened in this field yet and it’s unclear when or if it will.

    CMS didn’t respond to requests for comment.

    Thirty-five percent of women who visit a RadNet facility for mammograms pay for the additional AI review, Sorensen said.

    Radiology practices don’t handle payment for AI mammography all in the same way.

    The practices affiliated with Boston-based Massachusetts General Hospital don’t charge patients for the AI analysis, said Constance Lehman, a professor of radiology at Harvard Medical School who is co-director of the Breast Imaging Research Center at Mass General.

    Asking patients to pay “isn’t a model that will support equity,” Lehman said, since only patients who can afford the extra charge will get the enhanced analysis. She said she believes many radiologists would never agree to post a sign listing a charge for AI analysis because it would be off-putting to low-income patients.

    Sorensen said RadNet’s goal is to stop charging patients once health plans realize the value of the screening and start paying for it.

    Some large trials are underway in the United States, though much of the published research on AI and mammography to date has been done in Europe. There, the standard practice is for two radiologists to read a mammogram, whereas in the States only one radiologist typically evaluates a screening test.

    Interim results from the highly regarded MASAI randomized controlled trial of 80,000 women in Sweden found that cancer detection rates were 20% higher in women whose mammograms were read by a radiologist using AI compared with women whose mammograms were read by two radiologists without any AI intervention, which is the standard of care there.

    “The MASAI trial was great, but will that generalize to the U.S.? We can’t say,” Lehman said.

    In addition, there is a need for “more diverse training and testing sets for AI algorithm development and refinement” across different races and ethnicities, said Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington School of Medicine. 

    The long shadow of an earlier and largely unsuccessful type of computer-assisted mammography hangs over the adoption of newer AI tools. In the late 1980s and early 1990s, “computer-assisted detection” software promised to improve breast cancer detection. Then the studies started coming in, and the results were often far from encouraging. Using CAD at best provided no benefit, and at worst reduced the accuracy of radiologists’ interpretations, resulting in higher rates of recalls and biopsies.

    “CAD was not that sophisticated,” said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society. Artificial intelligence tools today are a whole different ballgame, he said. “You can train the algorithm to pick up things, or it learns on its own.”

    Smith said he found it “troubling” that radiologists would charge for the AI analysis.

    “There are too many women who can’t afford any out-of-pocket cost” for a mammogram, Smith said. “If we’re not going to increase the number of radiologists we use for mammograms, then these new AI tools are going to be very useful, and I don’t think we can defend charging women extra for them.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Glycemic Index vs Glycemic Load vs Insulin Index

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How To Actually Use Those Indices

    Carbohydrates are essential for our life, and/but often bring about our early demise. It would be a very conveniently simple world if it were simply a matter of “enjoy in moderation”, but the truth is, it’s not that simple.

    To take an extreme example, for the sake of clearest illustration: The person who eats an 80% whole fruit diet (and makes up the necessary protein and fats etc in the other 20%) will probably be healthier than the person who eats a “standard American diet”, despite not practising moderation in their fruit-eating activities. The “standard American diet” has many faults, and one of those faults is how it promotes sporadic insulin spikes leading to metabolic disease.

    If your breakfast is a glass of orange juice, this is a supremely “moderate” consumption, but an insulin spike is an insulin spike.

    Quick sidenote: if you’re wondering why eating immoderate amounts of fruit is unlikely to cause such spikes, but a single glass of orange juice is, check out:

    Which Sugars Are Healthier, And Which Are Just The Same?

    Glycemic Index

    The first tool in our toolbox here is glycemic index, or GI.

    GI measures how much a carb-containing food raises blood glucose levels, also called blood sugar levels, but it’s just glucose that’s actually measured, bearing in mind that more complex carbs will generally get broken down to glucose.

    Pure glucose has a GI of 100, and other foods are ranked from 0 to 100 based on how they compare.

    Sometimes, what we do to foods changes its GI.

    • Some is because it changed form, like the above example of whole fruit (low GI) vs fruit juice (high GI).
    • Some is because of more “industrial” refinement processes, such as whole grain wheat (medium GI) vs white flour and white flour products (high GI)
    • Some is because of other changes, like starches that were allowed to cool before being reheated (or eaten cold).

    Broadly speaking, a daily average GI of 45 is considered great.

    But that’s not the whole story…

    Glycemic Load

    Glycemic Load, or GL, takes the GI and says “ok, but how much of it was there?”, because this is often relevant information.

    Refined sugar may have a high GI, but half a teaspoon of sugar in your coffee isn’t going to move your blood sugar levels as much as a glass of Coke, say—the latter simply has more sugar in, and just the same zero fiber.

    GL is calculated by (grams of carbs / 100) x GI, by the way.

    But it still misses some important things, so now let’s look at…

    Insulin Index

    Insulin Index, which does not get an abbreviation (probably because of the potentially confusing appearance of “II”), measures the rise in insulin levels, regardless of glucose levels.

    This is important, because a lot of insulin response is independent of blood glucose:

    • Some is because of other sugars, some some is in response to fats, and yes, even proteins.
    • Some is a function of metabolic base rate.
    • Some is a stress response.
    • Some remains a mystery!

    Another reason it’s important is that insulin drives weight gain and metabolic disorders far more than glucose.

    Note: the indices of foods are calculated based on average non-diabetic response. If for example you have Type 1 Diabetes, then when you take a certain food, your rise in insulin is going to be whatever insulin you then take, because your body’s insulin response is disrupted by being too busy fighting a civil war in your pancreas.

    If your diabetes is type 2, or you are prediabetic, then a lot of different things could happen depending on the stage and state of your diabetes, but the insulin index is still a very good thing to be aware of, because you want to resensitize your body to insulin, which means (barring any urgent actions for immediate management of hyper- or hypoglycemia, obviously) you want to eat foods with a low insulin index where possible.

    Great! What foods have a low insulin index?

    Many factors affect insulin index, but to speak in general terms:

    • Whole plant foods are usually top-tier options
    • Lean and/or white meats generally have lower insulin index than red and/or fatty ones
    • Unprocessed is generally lower than processed
    • The more solid a food is, generally the lower its insulin index compared to a less solid version of the same food (e.g. baked potatoes vs mashed potatoes; cheese vs milk, etc)

    But do remember the non-food factors too! This means where possible:

    • reducing/managing stress
    • getting frequent exercise
    • getting good sleep
    • practising intermittent fasting

    See for example (we promise you it’s relevant):

    Fix Chronic Fatigue & Regain Your Energy, By Science

    …as are (especially recommendable!) the two links we drop at the bottom of that page; do check them out if you can

    Take care!

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  • A New Tool For Bone Regeneration
  • Heal Your Stressed Brain

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Rochelle Walsh, therapist, explains the problem and how to fix it:

    Not all brain damage is from the outside

    Long-term stress and burnout cause brain damage; it’s not just a mindset issue—it impacts the brain physiologically. To compound matters, it also increases the risk of neurodegenerative diseases. While the brain can indeed grow new neurons and regenerate itself, chronic stress damages specific regions, and inhibits that.

    There are some effects of chronic stress that can seem positive—the amygdalae and hypothalamus are seen to grow larger and stronger, for instance—but this is, unfortunately, “all the better to stress you with”. In compensation for this, chronic stress deprioritizes the pre-frontal cortex and hippocampi, so there goes your reasoning and memory.

    This often results in people not managing chronic stress well. Just like a weak heart and lungs might impede the exercise that could make them stronger, the stressed brain is not good at permitting you to do the things that would heal it—preferring to keep you on edge all day, worrying and twitchy, mind racing and body tense. It also tends to lead to autoimmune diseases, due to the increased inflammation (because the body’s threat-detection system as at “jumping at own shadow” levels so it’s deploying every defense it has, including completely inappropriate ones).

    Notwithstanding the “Heal Your Stressed Brain” thumbnail, she doesn’t actually go into this in detail and bids us sign up for her masterclass. We at 10almonds however like to deliver, so you can find useful advice and free resources in our links-drop at the bottom of this article.

    Meanwhile, if you’d like to hear more about the neurological woes described above, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

    Don’t Forget…

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  • Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.

    Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.

    Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”

    As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.

    Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.

    The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.

    Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.

    But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.

    Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.

    Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.

    “If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”

    From Pioneer to Lagger

    California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.

    The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.

    Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.

    In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.

    When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.

    Fall From Grace

    Morrow’s troubles started long after the original California program had been shut down.

    The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.

    But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.

    The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.

    Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”

    By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”

    Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.

    “I didn’t have to feel naked and judged,” she said.

    Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.

    Physician Privacy vs. Patient Protection

    The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.

    Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.

    Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.

    Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.

    “To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.

    Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.

    The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.

    People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.

    “The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.

    The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.

    Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.

    “I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • More Salt, Not Less?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝I’m curious about the salt part – learning about LMNT and what they say about us needing more salt than what’s recommended by the government, would you mind looking into that? From a personal experience, I definitely noticed a massive positive difference during my 3-5 day water fasts when I added salt to my water compared to when I just drank water. So I’m curious what the actual range for salt intake is that we should be aiming for.❞

    That’s a fascinating question, and we’ll have to tackle it in several parts:

    When fasting

    3–5 days is a long time to take only water; we’re sure you know most people fast from food for much less time than that. Nevertheless, when fasting, the body needs more water than usual—because of the increase in metabolism due to freeing up bodily resources for cellular maintenance. Water is necessary when replacing cells (most of which are mostly water, by mass), and for ferrying nutrients around the body—as well as escorting unwanted substances out of the body.

    Normally, the body’s natural osmoregulatory process handles this, balancing water with salts of various kinds, to maintain homeostasis.

    However, it can only do that if it has the requisite parts (e.g. water and salts), and if you’re fasting from food, you’re not replenishing lost salts unless you supplement.

    Normally, monitoring our salt intake can be a bit of a guessing game, but when fasting for an entire day, it’s clear how much salt we consumed in our food that day: zero

    So, taking the recommended amount of sodium, which varies but is usually in the 1200–1500mg range (low end if over aged 70+; high end if aged under 50), becomes sensible.

    More detail: How Much Sodium You Need Per Day

    See also, on a related note:

    When To Take Electrolytes (And When We Shouldn’t!)

    When not fasting

    Our readers here are probably not “the average person” (since we have a very health-conscious subscriber-base), but the average person in N. America consumes about 9g of salt per day, which is several multiples of the maximum recommended safe amount.

    The WHO recommends no more than 5g per day, and the AHA recommends no more than 2.3g per day, and that we should aim for 1.5g per day (this is, you’ll note, consistent with the previous “1200–1500mg range”).

    Read more: Massive efforts needed to reduce salt intake and protect lives

    Questionable claims

    We can’t speak for LMNT (and indeed, had to look them up to discover they are an electrolytes supplement brand), but we can say that sometimes there are articles about such things as “The doctor who says we should eat more salt, not less”, and that’s usually about Dr. James DiNicolantonio, a doctor of pharmacy, who wrote a book that, because of this question today, we’ve now also reviewed:

    The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life – by Dr. James DiNicolantonio

    Spoiler, our review was not favorable.

    The body knows

    Our kidneys (unless they are diseased or missing) do a full-time job of getting rid of excess things from our blood, and dumping them into one’s urine.

    That includes excess sugar (which is how diabetes was originally diagnosed) and excess salt. In both cases, they can only process so much, but they do their best.

    Dr. DiNicolantino recognizes this in his book, but chalks it up to “if we do take too much salt, we’ll just pass it in urine, so no big deal”.

    Unfortunately, this assumes that our kidneys have infinite operating capacity, and they’re good, but they’re not that good. They can only filter so much per hour (it’s about 1 liter of fluids). Remember we have about 5 liters of blood, consume 2–3 liters of water per day, and depending on our diet, several more liters of water in food (easy to consume several more liters of water in food if one eats fruit, let alone soups and stews etc), and when things arrive in our body, the body gets to work on them right away, because it doesn’t know how much time it’s going to have to get it done, before the next intake comes.

    It is reasonable to believe that if we needed 8–10g of salt per day, as Dr. DiNicolantonio claims, our kidneys would not start dumping once we hit much, much lower levels in our blood (lower even than the daily recommended intake, because not all of the salt in our body is in our blood, obviously).

    See also: How Too Much Salt Can Lead To Organ Failure

    Lastly, a note about high blood pressure

    This is one where the “salt’s not the bad guy” crowd have at least something close to a point, because while salt is indeed still a bad guy (if taken above the recommended amounts, without good medical reason), when it comes to high blood pressure specifically, it’s not the worst bad guy, nor is it even in the top 5:

    Hypertension: Factors Far More Relevant Than Salt

    Thanks for writing in with such an interesting question!

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